Surgical technology international
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Review
Incisional Application of Negative Pressure for Nontraumatic Lower Extremity Amputations: A Review.
In the environment of diabetes and peripheral vascular disease (PVD), there is a high risk of incisional complications following amputation, including seroma, hematoma, infection, and dehiscence. Incisional negative-pressure wound therapy (iNPWT) is a novel application of negative-pressure wound therapy (NPWT) that may be able to mitigate these complications and reduce the need for revisional surgery (including higher-level major lower-extremity amputations). It may also facilitate an increased rate of healing and earlier return to function. iNPWT has been used successfully in high-risk patients to decrease complications. ⋯ As of yet, no prospective, randomized trial has shown reduced morbidity, earlier return to function, or reduced mortality with the use of iNPWT after a lower-extremity amputation. This review presents recent findings regarding the use of iNPWT. Further studies on this topic are needed.
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Review Comparative Study
Injection Alternatives for the Management of Knee Osteoarthritis Pain.
There has been a rapid increase in opioid-related morbidity and mortality worldwide, and the dangers of excessive opioid use have been observed in patients with chronic musculoskeletal pain, including those diagnosed with knee osteoarthritis. Pain management is an important component of nonoperative treatment in knee osteoarthritis and frequently entails the use of opioids. However, this management technique is not without risks, such as addiction, morbidity, and mortality. Therefore, the purpose of this study was to review the existing literature on the use of opioids in the management of knee osteoarthritis and compare the findings to a new injection management modality. Specifically, we assessed: 1) trends in opioid prescription; 2) patient-reported outcomes; 3) incidence of complications; 4) incidence of abuse and dependence; and 5) mortality related to opioid use in knee osteoarthritis. We then performed a sub-analysis comparing these findings to TG-C, a novel a 3:1 mixture of genetically engineered chondrocytes that has shown promising early phase I, II, and III results. ⋯ The effects of the opioid epidemic on patients with knee osteoarthritis are severe. Excessive opioid use in these patients leads to poorer patient satisfactions as well as increased morbidities and mortalities. Therefore, there is a real need for alternative nonoperative treatment options that effectively reduce pain, and promising results from studies on the efficacy GEC injections demonstrate that they may be an answer to the opioid epidemic observed among osteoarthritis patients.
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Total knee arthroplasty (TKA) results in significant postoperative pain and a demanding postoperative path for recovery. This study was conducted to determine whether a femoral nerve block (FNB) or a periarticular injection of liposomal bupivacaine with an adductor canal block (LB+ACB) is superior for pain management. ⋯ LB+ACB proved to be an equally effective postoperative TKA pain management tool compared to FNB while displaying superiority in other increasingly important areas such as length of stay and cost. The larger amount of narcotic consumption is a concern, however, and there may be a small population of patients for whom LB+ACB is not the best option.
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Treatment of isolated lateral compartment arthritic disease with partial knee arthroplasty remains underutilized in comparison to medial unicompartmental arthroplasty. This study examines the survival and outcome of lateral unicompartmental arthroplasty utilizing the first implant specifically developed for the lateral compartment. ⋯ At early follow up, lateral unicompartmental arthroplasty using a modified surgical technique and an implant specifically designed for the lateral compartment is a reliable treatment for isolated lateral femorotibial arthritis when meeting defined indications.